| What is the full name of child? | Ullman. Margaret Eleanor |
| When was the child born? | May 26th. 13. |
| Where was the child born? | 128 Stinson St. |
| Male or Female | F |
| Are the parents married? | Yes |
| Full name of Father | Wilfred Ullman |
| Occupation of Father? | Clerk |
| Full Maiden Name of Mother | Ethel Kirk McKenzie |
| If she has been more than once married give names of former husband, or husbands | |
| Where were the parents married? | Hamilton |
| When were they married? | Aug 22nd. 11. |
| If not married give full Name of Mother | |
| Is she single or a Widow? | |
| What is her occupation? | |
| Name of Physician attending | A.E.J. Lannin |
| Your relation to child | Father |
| Were you in house at time of Birth? | No |
| Certified by | Wilfred Ullman |
| Address | 122 Stinson St. |
| Date | June 10th. 13. |
| Remarks |
Source: Archives of Ontario; Series: MS929; Reel: 244
Source: Ancestry.com. Ontario, Canada Births, 1869-1913